The Role of Placental Pathology in the Evaluation of Interpersonal Violence: A Case of Abdominal Gunshot Wound in a 27-Week Gravid Uterus

Abstract

We present a 17-year-old G1P0 Asian American woman with a previously undiagnosed pregnancy who sustained an intra-abdominal gunshot wound at 27 weeks' gestation. Within 2 hours of the traumatic event, the victim was taken emergently to the operating room for exploratory laparotomy. Findings included a gravid uterus with two entrance wounds and two small exit wounds with active bleeding from the right broad ligament. The fetus was bradycardic but viable, having suffered a gunshot wound to the left shoulder. Evaluation of the placenta revealed no sequelae from the acute event. Unexpectedly, two older, green, 7.0 cm retromembranous hematomas were present, both ringed by hemosiderin-laden macrophages. These hemorrhages clearly preceded the acute event. Although these findings seemed suspicious for a history of prior abuse or trauma, corroborative clinical data were unavailable at the time of initial placental evaluation. However, days later, the victim admitted to a history of interpersonal violence, with previous abuse from her boyfriend, a fatal victim of the same attack. The old retroplacental hemorrhages proved to be the only physical documentation of her previous abuse.

Abruptio Placenta Caused by Gunshot Injury in Second Trimester: A Case Report

“…In this case AP had been caused by trauma due to a gunshot. The literature about trauma during pregnancy indicates that 4-8% of women with trauma are sufferred from their close partners [8,9]. In our case, the woman did not know who guilty was because she was exposed to this accident while attending the wedding of her neighbor.…”

Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports

“…Sixteen ( 16) of the 41 publications come from the United States, which accounts for 27% of published cases worldwide (Table 2). 4,[9][10][11]16,18,[21][22][23]25,26,31,[34][35][36]38 There were no cases of twins or higher order pregnancies. The mean maternal age of GSW patients was 26.7 years (25.1 years, abdominopelvic; 28.1 years, other), mean gestational age at which GSW occurred was 31 weeks 1 day (33 weeks 0 days, abdominopelvic; 29 wk 1 d, other) (Table 3).…”

Gunshot wound to the pregnant uterus: case report

“…For some specialists, conservative care is indicated when: the entrance wound is below the uterine fundus, the fetus is previable or dead, abdominal examination is negative and the urinalysis is negative for blood. Otherwise, surgical intervention is the standard care 32 . For others, this type of injury requires routine laparotomy 27 and is mandatory when the penetrating wound is upper or rear, and if the fetal or maternal commitment is evident 28 .…”